An International Update
Now that we know how the U.S. is advancing, we have to ask: what is the status of accessible reproductive and sexual healthcare throughout the rest of the world? In this episode, we set the scene. Jonathan Rucks from PAI discusses how women and girls in developing countries may achieve access to family planning initiatives while he also helps us tackle the international side of reproductive health.
The Obama administration fully supported family planning funding and maintained the U.S.’ role as the largest bilateral donor. Reinforcing the right of women and girls’ access to a full range of contraception services while simultaneously combating preexisting stigma both in private homes and communities was the ultimate goal abroad.
But, immediately after Trump’s inauguration, the administration announced a vastly expanded Global Gag Rule (originally born under the Reagan administration in 1984), which prevents foreign NGO’s receiving any U.S. global health assistance if they are providing, counseling, or referring abortion as a healthcare option. The results are catastrophic: clinics will close, women and girls will have limited access to reproductive health services, and the levels of both abortions and unintended pregnancies will rise. The administration has also pulled funding from the United Nations Population Fund (UNFPA), the largest multilateral donor for sexual and reproductive health services abroad.
Both the House and Senate have introduced bills that combat the expanded global gag (H.R. 671 and S.210).
Links in this episode
PAI Facebook: https://www.facebook.com/paiwdc
PAI Twitter: https://twitter.com/pai_org
Information on H.R. 671: https://www.congress.gov/bill/115th-congress/house-bill/671
Information on S.210: https://www.congress. gov/bill/115th-congress/senate-bill/210
Transcript
Jennie: Welcome to rePROs Fight Back a podcast on all things repro. I'm your host Jennie Wetter. In each episode, I'll be taking you to the front lines of the escalating fight over our sexual and reproductive health and rights at home and abroad. Each episode, I will be speaking with leaders who are fighting to protect our reproductive health and rights to ensure that no one's reproductive health depends on where they live. It's time for repros to fight back.
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Jennie: Welcome to rePROs Fight Back a podcast on all things repro. I'm your host Jennie Wetter. In each episode, I'll be taking you to the front lines of the escalating fight over our sexual and reproductive health and rights at home and abroad. Each episode, I will be speaking with leaders who are fighting to protect our reproductive health and rights to ensure that no one's reproductive health depends on where they live. It's time for repros to fight back.
Jennie: Welcome to rePROs Fight Back. Uh, since this podcast is going to cover a range of domestic and international issues, I thought it was important to start the podcast series by doing some scene setting on some domestic and international reproductive health issues. This episode we're going to tackle the international side of reproductive health. So joining me today, I'm super excited to have Jonathan Rucks, the Director of Advocacy for PAI. Thanks for joining me, Jonathan.
Jonathan: Thanks for the invitation. Jennie.
Jennie: Before we get into what's happening now with, uh, sexual and reproductive health and rights, let's talk a little bit about, uh, how we got here in the state of, uh, reproductive health and rights in the developing world.
Jonathan: Sure. So what we're working for is to ensure that women and girls and developing countries have access to family planning. Uh, that's something that PAI, my organization focuses on, um, on a daily basis in our fight for sexual reproductive health and rights. The state of the world right now is that 214 million women in developing countries want access to family planning, but lack that, that access to modern contraceptives.
Jennie: Before we talk about what's happened under the Trump administration, let's kind of go back a little bit into the things that the Obama administration has done for reproductive health. So let's focus first on what happened to US funding for family planning.
Jonathan: The Obama administration fully believed in and supported family planning funding and maintained the US role as the largest donor, a bilateral donor for family planning funding. And really asserted its role and recognize that when um, the US stepped up and led in these efforts, other countries, other donor governments would follow.
Jennie: I know that's like a wide variety of programs that kind of fall under family planning. Do we want to talk about some of the different things that the US government has done around family planning?
Jonathan: Sure. The US uh, recognizes, um, the whole host of sexual reproductive health programs, right? So you're talking about not just ensuring that women and girls have access to contraceptives, but making sure that we're also funding important programs that reduce child marriage, that help to deal with fistula, for example, that provide a whole host of services. Um, sexual reproductive health care. Um, really making sure that these programs and services are integrated. So integrating family planning service delivery sites with access to HIV, uh, screening care and treatment. Um, making sure that at these same sites that women who bring their children, that they can be screened and immunized, um, receive nutrition counseling, um, maternal child health, all of these key interventions that really ensure that women survive and children thrive, that they're all provided at one location.
Jennie: I think that's a really important thing to talk about. That the, Obama administration data is kind of changing away from, well, there's still some funding silos, they started to see that you shouldn't have to access all of your different services in different places. There would be like HIV funding that would fund HIV clinic and then you might have to go somewhere else to get your family planning. And so there was really a push to integrate health services.
Jonathan: And I think a real recognition that it's efficient, it reduces costs, but it also is to the benefit of the individual. It makes sense for their convenience, for their wellbeing to have everything accessible in one location.
Jennie: Absolutely. You don't want to have to run all over to try and get in. And especially if you're in developing countries where maybe you're going to have to wait in line or wait to get an appointment or travel really far to access these services to have to travel multiple times or to multiple places to get it. It's easier to get a whole of care if it's all in one place.
Jonathan: That's exactly right and ensures that people will actually access those comprehensive services. And it puts the responsibility much more on the provider to make sure that they're all there, versus as you know, a whole host of things that could happen if you had to go from one place to another to receive all these services. Like life happens. Um, and access to those services could be very well, uh, interrupted.
Jennie: So I know we talked about the 214 million women who don't have easy access to modern methods. Do we want to talk a little bit about what that looks like in that, you know, it's access to a clinic or opposition within their house for using it or just kind of what that means?
Jonathan: Sure. I think there's a whole host of reasons that feed into that. Right. And this is, um, things that the advocacy community and number of the organizations that yours and mine work with all the time are really working to deal with. And that's ensuring that um, women and girls understand their right to access the methods, what method is going to make most sense for them, counteracting some myths and misconceptions to really unpack the, the concerns that an individual would have about a method that they're using. I think we also have to really focus on stigma, um, and opposition from within, not just households, but communities themselves. Um, and there's a lot of great work happening to get community leaders on board, faith leaders really in support of, uh, women's access to family planning methods.
Jennie: Yeah. I think that's a really important to think about because I think a lot of times when we talk about improving access to family planning services, people are thinking of just literal access at the clinic. And that's not always the biggest barrier. And that a lot of these programs that we're funding are also making sure to increase the other barriers, like addressing opposition or myths that are existing around family planning and that without addressing those, you're not going to improve women's ability to access services.
Jonathan: Exactly right. It's, you know, of course we have concerns about stockouts and providers making sure that those methods are available and they're actually providing those methods, um, and talking with women and girls about those methods. But again, like you said, it is beyond just a lack of access and we really have to understand when we say lack of access, what does that mean? And that's where it gets to dealing with, um, fears or misconceptions and, and community opposition.
Jennie: And also important, you know, we talk about stockouts that a lot of times it's stock outs of certain methods. And so not having the access to the full range of services. And so, you know, a lot of women choose injectables particularly, um, overseas. And so they don't have that coming back at a different time. They might not do that or finding the right method that works for them. They only have pills, but the women have side effects and don't want to use that. So it's trying to find the right balance to make sure that it's not just information, but access to all of the supplies and all of the various forms. T.
Jonathan: That's exactly right. I think we talk a lot about ensuring that there is method mix. So getting at those choices, but then really also ensuring that the woman herself has method choice so she can pick, her options aren't just limited to one or two methods that if she has a problem with her first method, that she then has an option and as adequate counseling to talk through an additional method to work through why that first one didn't work. Um, to really help her figure out what is best for her. Jennie: And I think another thing, so we were talking a lot about the women is that the Obama administration really started to change the way they viewed a lot of their aid and trying to center women and girls and youth. And that was a change from previous administrations. Do you want to maybe talk a little bit about what the Obama administration did to kind of send our women and girls and youth?
Jonathan: The Obama Administration really recognize young people as a vulnerable group and really worked to address a number of the challenges that adolescent girls are facing. Um, and came up with an adolescent girl strategy that they launched at the end of their administration to really target, um, several of these challenges. So you're talking about things again, like child early forced marriage, female genital mutilation, gender based violence and early pregnancy. Really figuring out how do we address these challenges that are facing adolescent girls in countries around the world.
Jennie: The Obama ministration did a lot of great things or took steps forward on reproductive health and centering women and girls. So all of that changed when the Trump administration came around. So I guess the first thing we should focus on is the global gag rule.
Jonathan: Yeah. I think, uh, it's important to note that this new administration, the Trump administration has really sent signals that they're no longer an advocate for women and girls' health and their access to sexual reproductive health care. And the actions that this administration is taking and policies that they're putting forward represents a real stepping back on the part of the US as a leader in global health, the global gag rule is incredibly damaging. Um, we know from past iterations what this policy does. It means that clinics will close, that women and girls will no longer have access to needed comprehensive health services. Unintended pregnancies will rise, um, and unsafe abortions will increase. The Trump administration not only took what is a terrible policy, they drastically expanded the policy. The policy in and of itself says that if you're a foreign NGO and you receive US global health assistance, that you can no longer provide counsel or refer for abortion and you can't advocate in your country for the liberalization of abortion laws. This is an incredible overreach on the part of this administration. They're telling foreign NGOs what they can and can't do with their private funds. And it's going to have drastic and terribly negative effects on, on health systems, on the health services that women and girls can access. Jennie: Have we started to see some effects already?
Jonathan: We are seeing some of those effects already, um, as foreign NGOs are having to agree to comply or not. Um, if they agree, if they're not going to comply, that means a loss of their US global health assistance. And we're already hearing from some countries, key implementing partners in those countries about how services are ending. You know, most Mozambique is already seeing the IPPF affiliate there is having to step away from a number of clinics that they're running. We're seeing impacts in Uganda, Kenya, Ethiopia. I think one of the other things that we're also seeing is not just the impacts but this real confusion around what this policy means, how this policy should be implemented, and what it means for partners who are working with other partners in, in country to provide key services. Um, and, and at PAI we're working with these partners to really try to break down and provide some technical assistance we call it, about here's, here's what you need to know about the policy and here's what you need to do moving forward.
Jennie: Yeah. It seems especially important because, because it is so vastly expanded and covers so many groups it didn't cover before, but it also covers in State Department bureaus that haven't had to deal with it before. So it seems like there's room for confusion in so many places.
Jonathan: That's exactly right. Uh, past iterations of the policy were limited to family planning assistance only. The expansion under the Trump administration expands the policy now to all global health assistance. So not just family planning assistance. You're talking about maternal child health, HIV/AIDS, tuberculosis, malaria, um, nutrition WASH. All of these programs now are being run by implementers who, if they weren't covered under family planning assistance last time, this is all new to them. I think it's also really important to point out, back to our earlier conversation about integration, that the way in which we deliver aid has vastly changed since the second George W. Bush administration when the policy was last in place. At that time, the aid structures were really siloed. So family planning assistance implementers were really only delivering that assistance. Now you have implementing partners that are delivering family planning services. They're also delivering maternal child health, nutrition, HIV. All of these things are so integrated. Again, all of these programs are now falling under this policy where they haven't in the past and it's requiring, um, organizations to really learn as much as they can about this and get up to speed as fast as they can. And a number of advocacy organizations are trying to work with these partners to mitigate the harm, um, and, and unintended consequences and, and really make sure that the policy isn't being overly implemented.
Jennie: Yeah, I feel like with this big expansion, you are having groups having to make really hard choices. You know, if they decide they really want to make sure that they are providing as many services as they can, then maybe they can't turn down the US money. And if they want to ensure that they are making sure women have full access to options, that puts organizations in a really hard place.
Jonathan: That's exactly right. And I think that we really have to recognize how challenging this policy is and what this does to an organization and how they have to grapple with it. And I think it's important to note that agreeing to comply with the policy doesn't necessarily mean a physical, philosophical, sorry, alignment with the policy. We have to recognize that some of these implementing partners are operating in countries, um, providing services where no other partner could step in and fill that gap. So if they make the tough decision to comply, that's because they recognize that in their absence there will be no services provided. Or worse yet a subpar partner would come in and provide, um, inadequate and services that aren't of high quality.
Jennie: Yeah. I mean you really see that with community relationships that have been developed or some of the really innovative programs that particularly family planning providers have tried to develop where they're getting out into mobile delivery and getting out into rural areas where there just aren't alternatives.
Jonathan: Yeah. I think one of the good and strong examples... There is something that's happening in Madagascar under MSI in Madagascar and they're funded by USAID to do just that, to do mobile outreach. And Madagascar, as you know, is, is not a donor darling. Um, USAID going in there and having MSI being the implementing partner really was a new entree. And MSI is not going to comply. Um, and when they're no longer eligible to receive US uh, funding as a result of that, that could be the end of that mobile outreach. And that means that those communities who are receiving services, those women and girls in those communities, will no longer have access to services. Um, because there just aren't a dearth, uh, there's a dearth of partners, um, in Madagascar.
Jennie: So the next thing that the Trump administration took aim at was United Nations Population Fund or UNFPA, which is how we'll probably be mostly referring to it as we go forward. Why did the Trump administration defund them? And what is UNFPA?
Jonathan: Uh, the United Nations Population Fund is, is the largest multilateral donor for key sexual reproductive health and rights services. So focusing on, not just delivering family planning, but really working to counteract child marriage, to ensure that there is treatment available for, um, female fistula, and ending female genital mutilation and a major player when it comes to, um, delivering services in humanitarian settings. And ensuring that um, women and girls and their families who are fleeing situations in Syria for example, or what we're seeing right now in Myanmar with the Rohinga, that they're able to access services when they go to camps that their health, um, is, is taken care of and provided for. Um, the Trump administration ended all funding to UNFPA based on a pretty bogus argument. I think a number of us in the community would argue, uh, about their work in China. And, and trying to say that because UNFPA is in China, that they're complicit in China's two child policy.
Jennie: Right. And we know that one, that's not what UNFPA's doing in China. They are working to assure voluntary services. But leaving that aside, UNFPA does great work. And I think the most clear example of where they are doing something where they cannot be easily replaced is focusing on their work in humanitarian settings where the US under the Obama administration has really ramped up their support. And that's a really large gap that the UN. Jonathan: FPA now needs to worry about filling. That's right. The US is I think the fourth largest donor when it comes to their humanitarian programs. And I think we can't underestimate that the loss of US funding is going to be catastrophic for vulnerable women and girls who are, who are in dire humanitarian situations. And they're going to suffer as a result of this policy.
Jennie: These are kind of the biggest two buckets of things that Trump has attacked on the international stage, but they've also had the loss of the US voice on these issues also cannot be understated, I think.
Jonathan: That's exactly right. I mean, I think if you look back to the Obama Administration, um, you're looking at an administration that really led on human rights, and spoke out when countries were trying to put forward damaging policies. I think it's the thing that comes to mind easiest is, is the Obama administration's response to Uganda's anti LGBT legislation and really asserting their position and their as, as a leader. And saying that if Uganda and move forward with that type of legislation that they would lose their US global health assistance. I think that we, we aren't going to see that same strong, um, human rights voice from this administration. And we're, we're seeing silence already, um, in, in response to things that are happening in countries around the world. Um, and I don't think that we can underestimate the fact that leaders in those countries know that there is not going to be pushback from, from this administration.
Jennie: The loss of the US voice on Human Rights is just tragic.
Jonathan: And I think that we've, we've seen that play out at the UN already. Um, and it's something that we need to be conscious of and be prepared as civil society organizations, not just here in Washington DC, but partnering with, um, civil society organizations around the world to make sure that we continue to lift up that voice and support, um, for human rights.
Jennie: Talking about things we can do, what can we do going forward?
Jonathan: One of the things that we're focused on at PAI is very much um, as I said earlier when it comes to the global gag rule, really making sure that our partners who are going to be impacted understand what this policy is and working with them to make sure that even though it's an incredibly restrictive policy that they know that there are things that can and should still happen. Making sure that in the cases of rape life and incest, that access, counseling and referral for abortion is provided. That post abortion care and treatment should still be provided. Really helping to understand and counteract this, this quick reaction to over implement the policy. You know, we refer to it as, as the chill that this policy has. We saw that play out last time. We're already seeing it play out. Um, and, and really counteracting and mitigating against that. We're also working with number of organizations to make sure that we're documenting that impact, especially under this massively expanded policy. Um, and trying to collect that evidence and anecdotal stories that we can use in our advocacy with champions here in Washington DC. But I think we also have to figure out how our counterparts in countries around the world can use that with their own governments to try to mitigate in country the harm that US policies are playing. Working with a number of partners on their own domestic resource mobilization, but also really enacting progressive policies in their countries. Because again, we can't count on the US to be a leader in the, in the policy world anymore and when in fact they're going to be anti progressive policies. We have legislation in Congress, the Global HER Act that would permanently repeal, uh, the global gag rule. And I think it's important to note and, and sort of champion all the great work that we've done over the past years to educate policy makers about the harm of this policy. And within 24 hours of the Trump administration's enactment and expansion of the global gag rule, we have bills with massive numbers of cosponsors in both the House and Senate.
Jonathan: When it comes to UNFPA, I think we have to continue to tell the story about the great work that they're doing and really make sure that, um, we, uh, the policymakers understand the loss, uh, what the loss of funding is going to mean for humanitarian situations around the world. Again, like I think about what's happening in Myanmar and, and, and the, the vast majority of those refugees who are fleeing Myanmar to Bangladesh are women and girls. And making sure that the services that they need are available. We didn't touch on it as much, but I think this administration also sent a pretty big signal when it comes to funding, um, for family planning and reproductive health. Um, the budget that they submitted to Congress earlier this year was the first time that Congress received a budget that had zero funding for family planning and reproductive health. And I think that zero speaks volumes to the value that this administration plays, uh, places on women and girls and the services that they need and should have access to.
Jennie: Absolutely. Yeah, that was a really big moment. And sorry I forgot about that.
Jonathan: No, it's okay. I mean, I think that what, you know, there are so many bad things that are happening that we get caught up and, and you know, just have to make sure that we're separating everything out and making sure that people understand that these are all clear and distinct policies that each will have harm, um, uh, as they play out around the world.
Jennie: Absolutely. Are there things that individuals can do? Actions they can take? Um, now that they know kind of some of these issues.
Jonathan: So I think it's important to make sure if your member of Congress isn't a cosponsor of the Global HER Act to make sure that they're on there. I think to the extent that we can, we all need to be talking about the importance of funding, not just family planning and reproductive health programs, but all of US global health, um, you know, family planning was zeroed out, but a number of global health programs, um, were slated for pretty drastic cuts as much as 30% by this administration. And we really have to underscore the importance of these investments and make clear that, especially when it comes to family planning and reproductive health, that the US um, contribution can't be made up by anyone else. Like we are truly the leader here around the world. And if zero, if that were to actually be enacted would have drastic impacts. You know, championing, um, multilateral organizations like UNFPA and really talking about the services that they provide, especially when it comes to humanitarian work. And really making sure that people understand that these decisions here in Washington have real world impact and they play out in incredibly consequential ways in countries around the world. And, and that's going to mean not just an, a loss of services to women and girls, but it's gonna mean increased maternal deaths and that will impact child survivability.
Jennie: I think that's the really important thing. And we talk about these policies, we can't let the people get lost and the people whose lives are going to be impacted be lost when we're talking about policy details.
Jonathan: I think that's exactly right. It's so easy just to get caught up in these decisions in Washington. And I think this is also where we as advocates need to really step up and make sure that we're bringing these personal stories. Um, these stories from the field to policy makers so they understand the consequences of their decisions. Um, and I think we really need to work with global leaders and ministries of health and, and have them also tell the story about how these decisions that this administration is making will undermine their own health systems in country and undermine all of the great work that has been, that the US has been doing for years, not just at the Obama administration, but years before that as well. That whole foundation is being wiped away, um, by the policies of this administration.
Jennie: Thank you, Jonathan, for being here.
Jonathan: Thank you, Jennie.
Jennie: For more information, including show notes from this episode and previous episodes, please visit our website reprosfightback.com you can also find us on Facebook and Twitter at rePROs Fight Back. If you like our show, please help others find it by sharing it with your friends and subscribing, rating and reviewing us on iTunes. Thanks for listening.